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Biomedical subjects

W Kirsch

Publications and source records attributed to W Kirsch.

At least 19 recordsLinked to original sources
PubMed1997

Nonpenetrating clips for coronary anastomosis.

BACKGROUND: A nonsuture clip technique (nonpenetrating titanium clips applied to everted tissue edges at high compressive forces) was used to perform coronary anastomoses in a clinical setting. METHODS: Clipped coronary anastomoses were performed in 10 patients. The anastomoses incorporated the left internal mammary artery to the left anterior descending artery (n = 1) and the saphenous vein to the right coronary artery (n = 5), the posterior descending artery (n = 2), the diagonal artery (n = 2), and one vein-to-vein proximal anastomosis (n = 1). RESULTS: The mean duration for completion of the anastomoses was 15 minutes (range, 7 to 20 minutes). This time was reduced from 20 minutes at the beginning of the clinical experience to 7 minutes for the last 3 patients. No technical complication was related to clip application and all patients had uneventful outcomes. Three anastomoses studied by coronary angiography were patent without stenosis. CONCLUSION: The clipped anastomotic technique has a rapid learning curve, the same safety as suture methods, and the potential for facilitating endoscopic vascular reconstructions.

Anastomosis, Surgical↗
PubMed1997

Neonatal adrenal abscesses.

Unilateral or bilateral suprarenal abscesses are rare in the neonate. We describe 2 cases, an 8-week-old Syrian female with a right, and a 6-week-old white female infant with a left adrenal abscess, both following adrenal hemorrhage. The etiology and treatment are discussed.

Abdominal Abscess↗
PubMed1995

Intrauterine repair of cleft lip-like defects in lambs with a novel microclip.

Potential for scarless wound healing in fetal surgeries has aroused interest in fetal repair of malformations such as cleft lip. However, current protocols for fetal surgery have entailed fetal externalization, imparting significant risks for mother and fetus. We have developed a unique silver microclip that rapidly approximates tissue, is nonpenetrating, and is well suited for endoscopic use. Using standardized intrauterine surgical techniques, we compared suture versus microclip in the repair of surgically created cleft-like defects in fetal lambs at 124 days' gestation (term, 145 days). Nine fetal lambs were analyzed with bilateral cleft lips; the right cleft was repaired by microclip, seven of the left clefts were repaired by suture, and the remaining two left clefts were not approximated (controls). Results demonstrated excellent wound healing and smooth lip continuity with minimal scar formation after repair by either microclip or suture. The most striking result, however, was in the comparison on intraoperative repair time; the total time for cleft lip repair by microclip averaged 2.5 minutes in contrast to 9.8 minutes for suture. These data suggest a distinct advantage of the microclip in reduction of operative time. Furthermore, its endoscopic application has the potential for making endoscopic fetal surgery a more viable option.

Animals↗
PubMed1990

Long-term Doppler ultrasound measurement through the anterior fontanel in neonates: choice of parameter for computer supported analysis.

There is no easy comparison of the Doppler spectra. Therefore, determining parameters is necessary for long-term measurements. A manual analysis is laborious, limits the number of possible examinations, and considerations are restricted to the envelope curve (maximal cerebral blood flow velocity). The applied ultrasonic apparatus (a modified HP 77020AC) determines three waveforms besides the Doppler spectrum: V max as maximal, V means as average, and V mode as the most frequently measured velocity. These data are directly transferred to a PC. Using low Doppler intensity V max resulted in values up to 39% lower than determined by manual analysis because of the apparatus' algorithm. By use of higher Doppler intensity this difference was reduced to 19%. Regarding clinical validity, the V s mean seemed to be the best parameter for further processing. Determining peak systolic velocity (V mean), end-diastolic velocity (V d mean), and mean velocity over time (V mean) were selected for standard analysis. The Pourcelot index was not taken into account, first for lack of definition for V mean and secondly for not missing simultaneous changes of the peak systolic and the end-diastolic velocity.

Blood Flow Velocity↗
PubMed1989

[Experiences with a combined sciatic and femoral block in surgery of injuries of the lower leg].

Besides various methods of general anaesthesia, regional anaesthetic procedures are well suited for the surgical care of traumatological patients. For operations on patients with lesions of the lower leg, we have been using for 3 years a combination of dorsolateral blockade of the sciatic nerve according to Winnie with a "3 in 1-block". Our experiences with 80 patients show that a complete anaesthesia of the operation field holds for about 100 minutes with a blockade using 1.5% lidocaine with adrenaline. Main indications of this method are operations on lesions of the fibular ligament, leg fractures, ankle joint fractures, removal of osteosynthesis metal and other operations on the leg or foot. Partial or complete failures were registered in 12% of the cases. Severe complications did not occur.

Adolescent↗
PubMed1979

Monitoring visual evoked response during craniofacial surgery.

A case is presented in which intraoperative visual evoked response (VER) monitoring was employed during correction of orbital hypertelorism. This procedure is noninvasive and does not interfere with the execution of the operation. The operative time is prolonged only a few minutes to record the VER. This technique is a simple and safe method for detecting intraoperative damage to the optic nerve and chiasm, and may prove useful in avoiding damage to these critical structures during craniofacial surgical procedures.

Child↗
PubMed1979

Hydrocephalus and amenorrhea.

A 25-year-old woman was seen for the complaint of secondary amenorrhea. Skull roentgenograms revealed a markedly enlarged sella turcica. Studies of pituitary and hypothalamic function including prolactin were normal. A pneumoencephalogram revealed dilated ventricles and a mass in the septum pellucidum and hypothalamus. Partial removal of this hypothalamic astrocytoma and placement of an interventricular shunt resulted in the return of menses. Recurrent obstruction a few months later resulted in headache, disorientation, and amenorrhea. A shunt was placed again, resulting in clearing of symptoms and a reestablishment of normal menstrual cyclicity. It appears that the occurrence of increased intracranial pressure rather than the hypothalamic tumor caused the amenorrhea.

Adult↗
PubMed1977

[Diagnostic therapeutic problems of defibrination syndrome in shock, sepsis, and neonatal hypoxia (author's transl)].

The diagnosis of defibrination syndrome in shock, sepsis and neonatal hypoxia is based, in addition to the clinical picture, upon a few parameters of the hemostatic system, which, in part as global tests, provide information about the course of coagulation. The parameters measured are partial thromboplastin time, thromboplastin time, plasma thrombin time, fibrinogen, thrombin-coagulase and reptilase times as well as platelet count. Normal values of these laboratory parameters were established for healthy newborns 1--5 days of age, and for healthy adults. It is suggested that especially partial thromboplastin time, the thrombin-coagulase and reptilase times, the latter influenced by fibrinolysis cleavage products, are representative for the tentative diagnosis of disseminated intravascular coagulation with fibrinolysis syndrome (DICFS). The platelet fall often lags 1--2 days behind the event. Moreover normal values for newborns, are markedly higher than those for older children or adults. In the presence of DICFS, a low-dose heparin therapy is immediately initiated. If completed defibrination is manifest, therapy is supplemented with urokinase and streptokinase, For DICFS with congenital sepsis, an exchange transfusion with heparinized fresh blood is the treatment of choice.

Asphyxia Neonatorum↗
PubMed1976

[Haemoglobin M-Homburg (author's transl)].

Haemoglobin M is a rare cause of congenital cyanosis and is usually misdiagnosed as being due to congenital heart disease. This was also the case in a family on whom this report is based. In five members of three generations the characteristic grey-blue cyanosis was due to a haemoglobin M anomaly. In all of them cardiopulmonary disease, anaemia and haemolysis had been excluded. The amino-acid substitution was in the alpha-chain of the globin molecule. Consequently the carriers of the trait have an abnormal haemoglobin content of 20-25%. Despite marked cyanosis they feel well.

Adolescent↗
PubMed1975

[Pathogenetic and therapeutic aspects of subacute sclerosing encephalitis (author's transl)].

This paper reports the case of a 20-year-old patient with subacute sclerosing leukoencephalitis who in spite of the severe illness was delivered of a healthy child be caesarean section. This child grew normally and showed no signs of disease of the CNS. The patient herself was treated immunsuppressively and the illness then reached a stationary state. The pathogenesis of subacute sclerosing leukoencephalitis, similarities of laboratory findings to multiple sclerosis, and problems of treatment are discussed.

Adult↗